Patient-Reported Long-Term Outcomes of Laparoscopic Sacrocolpopexy.

Abstract

<h4>Introduction and hypothesis</h4>Laparoscopic mesh sacrocolpopexy (LSC) is an effective treatment option for post-hysterectomy vault prolapse. The use of nonabsorbable mesh can be associated with adverse events (AEs) although long-term studies are lacking. This study aimed to report the rate of mesh-related AEs following LSC.<h4>Methods</h4>This is a cross-sectional postal questionnaire study of women who underwent LSC from 2011 to 2023 at a tertiary UK centre. Participants were identified through surgical databases.<h4>Results</h4>The primary outcome was patient-reported mesh complication requiring reoperation. Secondary outcomes included use of pain services, Patient Global Impression of Improvement (PGI-I) scores and reoperation for prolapse or incontinence. There was a 58% (n = 334) completion rate from 574 eligible women identified. The median follow-up was 116 months (range 11-221). The rate of reoperation for a mesh-related AE was 1.5% (n = 5) and 3% (n = 10) were under the care of a pain specialist due to mesh-related pain. When asked how their prolapse symptoms were compared to pre-LSC, 5.7% reported them as 'very much worse' or 'much worse', compared to 70.4% who rated their symptoms 'very much better' or 'much better'. The operative rate for recurrent prolapse was 12% (n = 41) and for stress incontinence 7% (n = 23).<h4>Conclusions</h4>At nearly 10 years following LSC, the risk of reoperation for a mesh-related AE in this large cross-sectional study is only 1.5% and rates of chronic pain service use are low. Reassuringly, most women report ongoing satisfaction with prolapse symptoms and rates of reoperation appear favourable. These data will support the counselling of women in the UK seeking abdominal mesh surgical treatment for post-hysterectomy vault prolapse.